A pain in the side

Edited 19 July 2006: It seems that this particular page on my site gets four or five hits a day from people looking for information about costal chondritis (or variants thereof). I’m quite glad to be getting the attention, of course, but it’s kind of funny because I put so much effort into the rest of my site. Well, at least some good is coming out of this.

I understand the frustration of looking for information about this condition. I found nothing at WebMD, which is my personal favorite medical site, nor at WikiPedia, which is my favorite reference site (a search there for “costal chondritis” brings up “Tietze’s Syndrome”, which I’m not sure is the same thing). I guess that the best I can say is, talk to your doctor. Ice, heat, and non-steroidal anti-inflammatories seem to work for me (but please don’t think this is medical advice), though my doctor now recommends against stretching the affected area.

And six months after I wrote this original entry, I still suffer from costal chondritis. I think it’s primarily because I haven’t been free of asthmatic symptoms long enough during that period of time to really give the muscles and cartilege a chance to recover. On the plus side, since the pain’s been there, at a constant level, for so long, I can now be positive that it isn’t anything more serious.

Today I decided to go back to the doctor for this pain in my side which has been bugging me since August. In early December, the doctor who looked at it — not my regular doctor, who’s currently on maternity leave, but a good one by all accounts anyway — said it was probably something called costal chondritis. Back then I had a chest X-ray done, and the results were clear (well, as clear as a life-long asthmatic’s can be, when there’s airway remodeling and permanent scarring on the lung tissue). But despite the icing and the stretching and the Ibuprofin, the pain has not gone away. In fact, over the past few days, it’s gotten significantly worse.

I saw the same doctor today, and he looked at the results of the X-ray, listened to my symptoms, and did a couple of quick prods on my rib cage — “Does it hurt when I press down on your rib cage with 8,000 psi of pressure?” — and so on. And said Yep, very likely costal chondritis. But just to be sure, I get to go in for a bone scan this week, just to make sure there’s nothing there.

Because I am what I am, I naturally brought up the notion of cancer.

The doctor scoffed and told me that the odds of this being cancer are practically nil.

Anyway. So he explained costal chondritis more thoroughly this time, and I paid more attention. The “costal” part of the term refers to the ribs; you know, the bones that protect your heart and lungs and such. The ribs have cartilage between them to make sure they don’t rub together and damage each other. Between the bone and the rib is a joint; and it’s this joint which is out of whack. So, the cartilage is actually slipping because of the inflammation. Because this is happening, the smooth muscles surrounding the ribs — the intercostal muscles, a term I remember from the physiology classes I took in college — end up working harder to keep everything in place. But because this is not the sort of work the intercostal muscles are supposed to be doing, they wear out quickly and start to spasm. Pain ensues.

So, costal chondritis not only involves the inflammation along the costal/chondral joints, it also involves spasms of the intercostal muscles. The affected area could be just the bottom of your rib cage, or could extend all the way down the intercostal muscles and their associated muscles; from the collarbone, in other words, to just about the small of your back. That’s the affected area for me, though mostly it hurts at the bottom of my rib cage on my left flank.

The doctor believes this may have all started when I pulled a muscle in my back last August, and been exacerbated by a series of upper respiratory infections. This last cold, with all the coughing and the sneezing I had, probably just brought about the huge flareup I’m having now. There isn’t much I can do about it, though; take big doses of Iburprofin for a couple of weeks and see how it goes (in addition to the icing and the stretching), and if that doesn’t work, take a more aggressive approach. The doctor doesn’t like people to take anti-inflammatories if they can help it, but agrees that it’s time for that approach for me.

What it all boils down to, he explained, is normal wear and tear on the body, and it’s all probably exacerbated by the lifetime of asthma that I’ve had. Fortunately, I still have my pain management techniques that the neurologist taught me almost two years ago when I was dealing with my headaches, so I’ll break out that CD and see if I can get going on that again.

In other words: ouch. Frikkin’ ouch.

But other stuff is looking up. I’ve read through about four chapters of Fred Again and taken a lot of notes (including the huge, glaring, painful chronology issue right in chapter 2). And because I got a telescope for my birthday I’ve been listening to a lot of astronomy related podcasts, which are giving me ideas for the novel. 70% of the matter in the universe is dark matter, and no one knows what dark matter is. Except, of course, you and I know that it’s really just the ill will of Nyarlathotep and Azathoth that keep the universe together, right?